Protein synthesis inhibition in the basolateral amygdala following retrieval does not impair expression of morphine-associated conditioned place preference.

Conditioned place preference is an animal model used to evaluate the affective properties of natural rewards and drugs of abuse. This animal model is a kind of classical conditioning that depends on learning and memory. The basolateral amygdala (BLA) plays an important role in the consolidation and extinction of memory for this task. However, there is a lack of evidence demonstrating protein synthesis dependent reconsolidation following retrieval in conditioned animals. In other words, is it possible to observe morphine-associated place preference if recall of this preference is disrupted? Accordingly, we investigated this hypothesis by BLA infusion of protein synthesis inhibitor, anisomycin, immediately after retrieval (test) in conditioned place preference paradigm. In the first experiment, the conditioned animals were exposed to the two sides of the apparatus for 15 min in a drug-free state during retrieval. In the second experiment, the animals received an injection of morphine (7.5 mg/kg, i.p.) and immediately after, they were exposed to the two sides of the apparatus for 15 min. Finally in the third experiment, after habituation and training in the conditioned place preference task, the animals received an injection of the unconditioned stimulus (morphine, i.p.; 7.5 mg/kg) followed by confinement for 10 min in the morphine-paired compartment (conditioned stimulus) during memory retrieval. For the three experiments the animals were subsequently exposed in a free-drug state to the two sides of the apparatus for the retest. Our results show that the protein synthesis inhibition in all of these experimental designs had no effect on conditioned place preference memory under conditions that would initiate reconsolidation, suggesting that if reconsolidation of a conditioned place preference task exists it is not mediated by protein synthesis in basolateral amygdala. The effect of anisomycin on consolidation of contextual fear conditioning was also investigated as a positive control to assure that the negative results were not due to methodological problems. Using the same dose of anisomycin (62.5 microg/1 microl) in morphine-associated place preference procedures, we have found that this anisomycin dose blocks the consolidation of contextual fear memory, ruling out the possibility that these negative results can be attributed to methodological problem of some sort.

Spontaneous development of paraplegia after repair of coarctation of the aorta.

This report describes the case of a 19-month-old boy in whom paraplegia developed spontaneously 2 days after a technically uncomplicated coarctation of the aorta repair.

Surgical treatment of endomyocardial fibrosis.

Thirty patients with endomyocardial fibrosis were submitted to endocardial decortication and atrioventricular valve replacement between December, 1977, and October, 1981. There were 26 female and four male patients, ranging in age from 14 to 48 years (mean 32). Thirteen patients had biventricular disease, 14 had the right-sided form, and three had endomyocardial fibrosis confined to the left ventricle. All were in Functional Class III or IV (New York Heart Association classification). The hospital mortality was 20% (six cases). Among the survivors (mean follow-up 13 months), 23 of 24 were improved clinically. Postoperative hemodynamic and angiographic studies were performed in 15 patients. Two (6.6%) have definitive atrioventricular heart block. There were five (16.6%) late deaths. Operation for endomyocardial fibrosis should be considered a palliative procedure. Possible limitations include the need for a valve prosthesis, cardiac conduction disturbances secondary to endocardiectomy of the right ventricle, and the possibility of recurrence of the endocardial fibrosis. However, at present, operation seems to be the treatment of choice for this condition because (1) endomyocardial fibrosis is characterized by a grave prognosis and medical therapy is ineffective; (2) endomyocardial fibrosis is a disease in which only the heart is affected, lesions in other organs being the result of passive congestion; (3) systolic performance of the heart is usually only slightly depressed; and (4) the surgical procedure is easily performed, so that the mortality is acceptable.

Endomyocardial fibrosis: report of 6 patients and review of the surgical literature.

Six patients with endomyocardial fibrosis were treated by endocardium decortication and atrioventricular valve replacement. There were 5 female patients and 1 male patient ranging from 14 to 48 years old (mean, 30 years). Four patients had involvement of the right ventricle, 1 patient had involvement of the left ventricle, and 1 patient had biventricular disease. There was 1 operative death due to low cardiac output state (the patient with biventricular endomyocardial fibrosis), and there was 1 late noncardiac death. The surgical literature, which describes 19 previously reported cases, was reviewed. On the basis of the results of this series and those of the reported cases, it is concluded that surgical treatment of endomyocardial fibrosis is feasible and provides good clinical improvement.

Long-acting oral bromocriptine (Parlodel SRO) in the treatment of hyperprolactinemia.

OBJECTIVES: To compare the effect of Parlodel SRO (Sandoz, Basel, Switzerland), a long-acting oral bromocriptine, to Parlodel (Sandoz) and to study the chronic effects of Parlodel SRO. DESIGN: The study was twofold: (1) random, double-blind and (2) open. SETTING: Patients were studied in an academic environment. PATIENTS: Hyperprolactinemic patients were selected. Sixteen patients were treated during 1 month. Ten patients completed the 1-year follow-up. INTERVENTIONS: Parlodel SRO or Parlodel was administered during 1 month (first 15 days: 5 mg/d; afterwards: 10 mg/d). Parlodel SRO was given during 1 year in variable doses (maximal 20 mg/d). MAIN OUTCOME MEASURES: Prolactin (PRL) levels, clinical improvement, and side effects were evaluated. RESULTS: After 1 month, 63% of the patients in both groups had normal PRL and 43% had menses. Side effects were similar. After 1 year all patients except one had normal PRL levels, and 89% were ovulating. CONCLUSIONS: The efficacy, tolerability, and long duration of action of Parlodel SRO make it an excellent alternative for the treatment of hyperprolactinemic patients.

Congenital aneurysm of the right atrium.

Congenital aneurysm of the right atrium is described in a 1-year-old girl who presented with cardiomegaly and symptoms of paroxysmal supraventricular tachycardia. Echocardiography and cineangiography both established the definitive diagnosis and surgical resection was successful. The rarity of this condition is pointed out and its main features outlined.

Surgery for endomyocardial fibrosis revisited.

OBJECTIVE: To identify life expectancy after surgery for endomyocardial fibrosis (EMF) and the events that influence it. METHODS: Eighty-three patients with EMF underwent endocardial decortication and atrioventricular valve replacement or repair, between December 1977 and December 1997. There were 66 (79.6%) female and 17 (20.4%) male patients, ranging in age from 4 to 59 years (mean, 31). Thirty-seven (44.5%) had biventricular disease, 34 (41.0%) had disease of the right ventricle alone and 12 (14.5%) had EMF confined to the left ventricle. All were in functional class III or IV (New York Heart Association classification). RESULTS: Sixty-eight (81.9%) patients survived the operation and were followed up for periods ranging from 2 months to 17 years. The total follow-up time was 6290 patient/months (mean, 92 months). There were 15 late deaths, but in six, the cause was not related to the underlying disease. Four (5.8%) patients presented recurrence of the fibrosis and were reoperated on and in six (8.8%), EMF appeared in the other ventricle. Five (7.3%) patients were reoperated on to replace either a valve prosthesis or a native valve which had been preserved during the first procedure. Only 24 (45%) of the 53 surviving patients are in functional class I or II. The actuarial probability of survival at 17 years, including operative mortality, was 55%. CONCLUSION: Surgical treatment of EMF should be considered a palliative procedure because surgery does not alter the progressive nature of the disease. However, surgical therapy is recommended for patients with EMF and heart failure as it is their only hope of survival.

Early surgical results in the treatment of endomyocardial fibrosis. A Brazilian cooperative study.

This report summarizes the surgical experience and early results obtained at four surgical centers in the northeast and south of Brazil. From December 1977 to September 1986, 95 operations were performed on 93 patients, ages 11-59. Bilateral lesions occurred in 42 patients, right lesions in 39, and left lesions in 12. Ventricular decortication and removal of thrombi were performed in all. In right-sided lesions, the tricuspid valve was substituted by a bioprosthesis in 34 cases, and substituted by a tilting disk valve in 1 case. In 4 patients, the valve could be preserved. The left-sided lesions led to valve substition by a bioprosthesis in 11 cases, and preservation of the valve in 1. The bilateral lesions needed bioprosthesis in the mitral position in 37 patients, and a disk valve in 2. In these 39 instances, the valvular procedure was insertion of a tricuspid bioprosthesis. Three tricuspid and three mitral plasties were performed. The overall mortality was 20% (26.2% for bilateral lesions, 14.6% for the right-sided lesions, and 20% for the left-sided lesions). The main cause of death was low cardiac output. Aside from a variable degree of right and left ventricular failure, many other non-fatal complications clouded the postoperative course. Complete AV blocks occurred in 10 cases, with the need for permanent pacing in 7 survivors. The mortality and morbidity in the present series is in keeping with the results reported in current literature. Regarding the advanced stage of their patients' disease, the authors agree with the recommendation for earlier surgical intervention.

Inhibitory effect of calcitonin on growth hormone response to growth hormone releasing hormone in acromegaly.

1. A neuroendocrine role for calcitonin (CT) has been suggested by the finding of CT receptors in the hypothalamus. We have recently shown that salmon calcitonin (sCT) inhibits growth hormone releasing hormone (GHRH)-induced GH secretion in man by a mechanism apparently independent of changes in peripheral cortisol, glucose, calcium or parathyroid hormone levels. 2. We have further investigated the inhibitory action of sCT on GH secretion by studying the effects of sCT (100 MRC units, im) or placebo on basal and GHRH (1-29) NH2 (50 micrograms, iv) stimulated GH secretion in 6 acromegalic patients with active disease. 3. Basal GH levels were not altered by sCT administration (placebo: 136 +/- 99 micrograms/l vs sCT: 99 +/- 53 micrograms/l). However, the GH response to GHRH was decreased by sCT. The area under the curve was significantly smaller when patients were treated with sCT compared to placebo controls (placebo: 77202 +/- 57036 vs sCT: 64828 +/- 51909 micrograms min-1 l-1; P less than 0.02). No changes in glucose or calcium levels were observed. 4. These results demonstrate that sCT decreases GHRH-induced GH secretion in acromegalic patients. Although the mechanism of action of sCT on GH secretion is unknown, our results indicate that the inhibitory effect of this peptide on GH secretion is also observed in patients harboring pituitary adenomas.

Successful excision of an intramural fibroma of the left ventricle.

A 2-year-old boy who presented with unrelated recurrent respiratory infections was found to have an enlarged cardiac silhouette on his chest roentgenogram. Clinical evaluation, echocardiography and cardiac cineangiograms failed to provide an accurate diagnosis. A left ventricular tumor was identified by exploratory thoracotomy and successful excision of an intramural fibroma of the left ventricle subsequently accomplished.

Phonomechanocardiographic findings in endomyocardial fibrosis.

Endomyocardial fibrosis (EMF) is a severe restrictive cardiomyopathy characterized by the formation of fibrous tissue on the endocardium and to a lesser extent in the myocardium of one or both ventricles. The disease results in endocardial rigidity, atrioventricular valve dysfunction and progressive obliteration of the ventricular cavity. The clinical and pathological findings of EMF have been well established and definitive diagnosis can be made by selective cineangiocardiography. However, there are few reports concerning the phonomechanocardiographic (PMCG) patterns in this condition. In this paper we describe the PMCG findings in 12 patients with EMF which is now recognized with increasing frequency in the Northeast of Brazil.

Technical aspects in surgery for endomyocardial fibrosis: experience with 37 patients.

The surgical technique of endocardiectomy and valve replacement for patients with uni- or biventricular endomyocardial fibrosis is described. Technical details of the operation are outlined, based upon experience with 37 surgical cases.

[Management of tricuspid atresia in neonates. Report of three cases and review of literature]. / Manuseio da atresia tricúspide em neonatos. Relato de três casos e revisão da literatura.

The present article describes the management of three neonates with tricuspid atresia and duct dependent pulmonary circulation referred to the Instituto de Coração de Pernambuco in November 1992. A brief literature review of the condition is added. Full diagnosis was established with echocardiography at the neonatal ICU; all of them were intubated, mechanically ventilated and started on PGE1 and Dopamine infusions. Within 10h to 24h of hospitalization, all were submitted to surgery. One patient died on the third postoperative day the other two were discharged in good clinical condition. Despite the small our experience shows that clinical and surgical management of tricuspid atresia with duct dependent pulmonary circulation can reach satisfactory results in our region providing that early diagnosis of cyanotic heart disease is established by the pediatrician with timely transferal of the neonate to a reference center in paediatric cardiology.

[Left main coronary artery angioplasty with circulatory support]. / Angioplastia do tronco da coronária esquerda com suporte circulatório.

A 60-year-old female with unstable angina was submitted to coronary arteriography. A 90% obstruction of the left main coronary artery ostium was detected, and the patient developed ventricular fibrillation. Circulatory support was instituted with cardiopulmonary bypass. Percutaneous transluminal coronary angioplasty was then successfully carried on. Ventricular fibrillation could be controlled and the patient was submitted to coronary artery bypass graft surgery 14 days later.

[Influence of age on the morbidity and mortality in coronary artery surgery]. / Influência da idade na morbidade e mortalidade da cirurgia arterial coronária.

To study the effects of age on the results of coronary artery bypass grafting (CABG), 250 patients operated on from 1986 to 1989 were divided into two groups: 1) less than 65 years of age and 2) older than 65. Pre, intra and postoperative data collected in all patients included: sex, type and class of angina, associated diseases, previous myocardial infarction, previous CABG, left ventricular aneurysm, bypass time, aortic cross-clamp time, number of grafts per patient, need for prolonged inotropic support, postoperative complications, and mortality. A large number of elderly patients had unstable angina (20.3% vs 6.2%), post-infarction angina (10.1% vs 7.8%), angina at rest (10.1% vs 3.6%), peripheral vascular disease (8.4% vs 2.6%), required prolonged inotropic support (18.6% vs 3.1%), had major neurological complications (8.4% vs 0.1%) and perioperative myocardial infarction (5.0% vs 0.5%). Overall mortality was 3.6% but mortality rates were significantly higher in elderly patients (11.8% vs 1.0%). These data suggest that elderly patients have an increased risk of cardiac and neurologic morbidity and mortality. It appear that the increased morbidity and mortality is related to an increased susceptibility of the elderly to serious postoperative complications.

[Tricuspid valve endocarditis in children]. / Endocardite da valva tricúspide em crianças.

Four children, three males, with ages 5, 1, 16 and 6 years, presented with isolated tricuspid valve endocarditis. Two of them were submitted to surgical treatment. Sepsis, cardiac murmur and heart failure were present in all of them. Three presented pulmonary embolism. Echocardiography demonstrated vegetation in the tricuspid valve in all cases. Two patients, one of them submitted to surgery, died. Tricuspid valve endocarditis in children with sepsis, heart failure and pulmonary embolism is a severe condition and early surgical treatment may diminished the high mortality.

[The heart transplant. The initial experience of the Instituto do Coração de Pernambuco]. / Transplante de coração. Experiência inicial no Instituto do Coração de Pernambuco.

PURPOSE: To describe the initial experience of a heart transplant program in Recife, Pernambuco. METHODS: Six patients in the final stage of heart failure were submitted to heart transplant. There were 4 male and 2 female patients, ranging in age from 15 to 61 years (mean, 43.8). Four had coronary heart disease and two dilated cardiomyopathy. The conventional operative technique of orthotopic heart transplant was used. All patients received a triple drug immunosuppressive therapy. RESULTS: There was one death due to acute rejection on the 28th postoperative day. The 5 survivors are in functional class I in a mean follow-up period of 113 days. CONCLUSION: The initial experience of a heart transplant program in Recife, Pernambuco, suggests that good long term results could be expected.

[Atrial septostomy at the intensive care unit under echocardiographic monitoring. Initial experience of the Heart Institute of Pernambuco]. / Atrioseptostomia em unidade de terapia intensiva sob monitorização ecocardiográfica. Experiência inicial do Instituto do Coração de Pernambuco.

The present article describes the initial experience of the Instituto do Coração de Pernambuco, at the neonatal intensive care unit, with the performance of Rashkind atrioseptostomy under two-dimensional echocardiographic control, through percutaneous venous approach (right femoral vein catheterization), under local anaesthesia, in three cases, two neonates with transposition of the great arteries and one with tricuspid atresia. In two children the procedure was successful both technically and haemodynamically. In the third child, aged 36 days, the atrial septum was thickened not allowing for satisfactory withdraw. In none of the three cases significant complications were observed during the procedure. Despite of the small number of patients, our experience showed that this new approach to the performance of Rashkind atrioseptostomy is feasible without major complications to the neonate and with advantages over the conventional technique.